SHOULDER PAIN AND A TRAINER’S REMEDY

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Recently, I’ve worked with athletes that express pain and discomfort in their upper back; right in between the shoulder blades, or even underneath the shoulder blades. Some have expressed also feeling this pain travel to the front of the shoulder, up into the neck, or down into the mid back. This referred pain from the shoulder to the neck and back can be a result of these muscle groups not working properly together. A common factor is that the body begins to compensate due to weaknesses in synergist muscles. To improve muscle synergy strength training exercises are ideal. I have interviewed a local trainer to provide the exercises for commonly weak muscle groups related to pain in between, in front, and/or underneath the shoulder blades. But, first let’s talk about some activities that can contribute to pain in these areas.

Common causes for shoulder/neck pain:

Those who partake in a multitude of physical activity including their line of work can suffer from this pain. These include:

●      runners; who tend to elevate and round their shoulders after long distances

●     cyclists; who ride with their chests to the handlebars

●     weight lifters; who add weight to the stress they put onto their bodies

●      working professionals hunched over their desks using phones, and/or computers

●     carpenters and construction workers working overhead or low to the ground, and

●     medical professionals; who often have to lift patients and carry medical tools around their necks

These are just a few activities to mention that people partake in, and all at some point in time experience pain in the shoulders. Other than work and exercise, the use of cellphones and laptops can contribute to the existing pain and discomfort. The use of these devices place stress on the neck and shoulders from looking down. Another daily activity is riding transit. To resist being tossed around on the bus or train, the body naturally tenses up. Some people do this while using their portable devices. These activities are added stress on the neck, shoulders, and back, so adding strength training to self-care is crucial. I have interviewed a local trainer to gather basic exercises to strengthen and stabilize the shoulders with the goal to reduce pain and discomfort in the upper back and neck. The following is a short bio of the trainer followed by some Q&A.

Personal trainer introduction:

Jamaal Green, Cali born and Philly bred, was born into a life of sports and fitness. With two military parents he has always been active with exercise and sports. Jamaal’s goal is to spread his health and fitness knowledge and to make an impact on others through exercise and training; with focuses in circuit training and lower/ upper body strength training. Jamaal suffered a torn ACL and nerve damage to the leg in the spring of 2017 which strengthened his passion to help others achieve success in rehab and body transformation. Jamaal uses an organic program that is tailored to each client’s needs and goals. His motto is “Build Results Until Happy,” B.R.U.H. Fitness. Whether your goal is to lose weight or build muscle, Jamaal is here to see you succeed!

Jamaal’s exercise recommendations for upper back/ neck relief:

Dynamic Stretching

In a standing position using an exercise ball and holding it centered to the body. Inhale, exhale and reach arms downward toward the floor on one side of the body, twisting the spine. Be mindful of hip and shoulder positions. Keep the hips centered, neck and shoulders stable, and feet planted. Inhale, swing arms upward toward the ceiling on the opposite side of the body, exhale and back to center repeat 10 times.

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Floor prone cobra

While lying face-down, bring arms above head. Squeeze the gluteal muscles, take a deep breath, and raise both arms and legs upward. Hold for 3-5 seconds, exhale, and lower arms and legs back down releasing the gluteal muscles last. Repeat 3 times.

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While lying face-down, keep arms at the sides of the body. Squeeze the gluteal muscles, take a deep breath, and raise chest and legs upward. Make sure to raise the chest up until just the upper abdomen is touching the floor. Hold for 3-5 seconds, exhale, and lower chest and legs back down releasing the gluteal muscles last. Repeat 3 times.

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Seated Military Press

In a seated position with 5-10lbs. weights in each hand, hold arms out on either side of the body. Elbows are away from the body and bent at a 45-degree angle. Squeeze the shoulder blades together, inhale and reach arms upward, careful not to touch weights together for specific muscle contraction, exhale and bring arms down to starting point releasing shoulder blades last. Repeat 10 times.

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Seated Reverse Flyes

In a nice and tall seated position with knees hips width apart, and bent at a 90-degree angle, hold arms out in front of the body at shoulder’s width apart. Be careful not to touch the weights together for specific muscle contraction. Take a deep breath and open the arms to each side of the body at shoulder height making sure to depress shoulder blades and squeeze them together. Exhale and bring arms back to center (keep arms out in front of the body). Repeat 10 times.

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Bent Over Cable Flyes

Similar to the Seated Reverse Fly, the Bent Over Cable Flyes are a step up. This exercise utilizes gravity as added resistance. In a standing position bend at the hips, upper body should be parallel to the floor, knees slightly bent, arms down, and eyes forward. With cables in each hand, or you may use free weights, squeeze the gluteal muscles, inhale and open arms to shoulder height squeezing the shoulder blades together (be mindful to keep the shoulders away from the ears). Exhale and slowly bring arms back down to center. Repeat 10 times.

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Soccer Throw

In a standing position using an exercise ball, inhale and reach arms upward toward the ceiling. Be mindful of neck and shoulder positions. Keep the chin up, eyes forward, depress shoulder blades and squeeze them together. Exhale, bring arms downward releasing the shoulder blades, bounce the ball, catch it, and repeat 10 times.

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Shoulder Shrugs

In a standing position, arms down to the sides of the body, weights in hand, inhale, squeeze shoulder blades together and elevate them toward the ears. Be mindful of neck position making sure the chin is up and eyes are forward. Hold for 3 seconds, exhale and slowly depress the shoulders down toward the floor, relax (don’t put down the weights) and repeat 3 times.

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Basic Shoulder Stretching

In a standing position, bring one arm up over the head placing the hand on the upper back, on top of the spine as close as possible. Bring the other arm also over the head and place the hand on the elbow or triceps of the opposite arm. Inhale and on the exhale; gently pull on the elbow or triceps using the resistance to squeeze the shoulder blades together and depress them. Make sure to stand nice and tall, chin up and eyes forward, Hold for 3 seconds while breathing comfortably and repeat 3 times. Switch sides and repeat the steps. 

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Basic Neck Stretching

This can be done in a seated or standing position. Place one arm at your side while placing a hand of the other arm on top of the head. Inhale, exhale and gently tilt the head toward the raised arm. Hold for 3 seconds while breathing comfortably and repeat 3 times. Switch sides and repeat the steps.

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Q&A:

Q: What types of tools should be used?

A: Exercise balls, resistance band, free weights.

Q: How many times should each exercise be performed per week?

A: For optimal results these exercises should be performed 3 times a week. Stretching should be before and after workouts, and incorporated in daily routines.

Q: How long after do you suggest these exercises be performed before noticing results?

A: 21 days is when the body initially begin to change. 6-8 weeks of consistency is key. Be sure to include breaks, rest, etc. in your routine.

Other ways to provide relief:

Outside of stretching and strength training exercising, regular massage and self-massage are other ways to provide pain relief. Massage will release tension in muscles and increase blood circulation to the area essentially, relieving pain and post workout muscle soreness. Your massage therapist will be able to provide several self-massaging tips and stretches. Further information on self-care, stretching, and exercises can be found here:

The Levator Scapulae - what a pain in the neck!

Self-massage for the upper back and neck area (video)

Sleep it on, Don't sleep on it!

Conclusion:

After learning about common activities that contribute to shoulder pain and about exercises to help relieve that pain, I encourage athletes to incorporate these exercises in their daily routines. Athletes will experience pain relief in their shoulders and in referred areas like the neck and back. They will also notice improvement in posture and muscle synergy. Along with stretching and strength training exercises, upper back and neck pain can be helped through regular massages and self-massages. The Phila Massages team and I can assist with any questions regarding upper back and neck pain. Jamaal can assist with questions regarding exercises, and can be reached via email: BRUHFitness@gmail.com, or Instagram: mg_errrday.

Pictures used with permission from Jamaal Green. 

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

 

 

 

Understanding Pain

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What is pain? Merriam-Webster defines pain as this: “Usually localized physical suffering associated with bodily disorder (such as a disease or an injury); also: a basic bodily sensation induced by a noxious stimulus, received by naked nerve endings, characterized by physical discomfort.” [1]

While pain was once classified as a sensation measuring the level of tissue damage, it is now accepted that pain is a “complex and highly sophisticated protective mechanism.”  So how does the body measure pain? While the body doesn’t exactly have “pain receptors” that immediately respond to pain, it does have a complicated network of specialized nerves called Nociceptors [2] that send signals to the brain warning of possible dangers like imbalances in homeostasis and sensation. These receptors send signals to the brain after said stimuli has passed a “high threshold” established by the nociceptors, once the threshold has been passed by a chemical, thermal or mechanical stimuli. The signals that they send to the brain are not exactly signals of‘pain’ because ‘pain’ is a sensation created in the brain (through the processing of large amounts of data and guided by factors like past experiences, expectation of pain and other sensory data) and sent to the areas of stimulation. The signal the brain sends back to the areas affected is the perception of pain. For example if one were to simultaneously grab onto a cold wire and a warm wire, the brain’s immediate reaction is “HOT!!’ and sends the message that it is a single burning hot wire in an attempt to protect the body from tissue damage. If the same person were to grab the wires individually the brain would respond accordingly, no longer receiving mixed signals and sending a signal of perceived pain.

PAIN IN SPORTS/MASSAGE

Many different forms of pain can be experienced in training and competition and those who experience it can also interpret it in many ways. For example a beginner athlete in weight lifting or running most likely has less of a tolerance for the sensations one might feel while training. A person new to weight lifting may take the burning of repetitions (positive training pain) as the sign of a problem (negative training pain), while a seasoned weightlifter would think nothing more of it than part of the process necessary to achieve hypertrophy. The same person could also mistake an actual injury as positive training pain when a veteran to lifting would recognize the sensation as a threat and react accordingly. Just as in sports, overtime one develops a sense of how a massage, intended to facilitate tissue recovery, should feel. A first time recipient of massage may be uncomfortable with the pressure that a veteran of massage may interpret as “too light”.  Recipients of massage both new and seasoned as well as the therapists they work with may find the use of a pain scale during massage to be very useful. It’s a good idea to incorporate a system of understanding in order to maximize client/therapist communication and achieve the greatest results.  Developing a pain scale such as the following could go a long way.

[5]

[5]

In conclusion, the sensation of pain is both complex and relative and should be treated as such. Not all pain is bad pain, but all pain is the brain’s way of sending a signal of possible danger.

 

References (viewed 8/31/17):

  1. https://www.merriam-webster.com/dictionary/pain
  2. https://www.sciencedaily.com/terms/nociceptor.htm
  3. http://www.appliedsportpsych.org/resources/resources-for-athletes/pain-tolerance-in-sport/
  4. https://www.google.com/amp/www.bodyinmind.org/what-is-pain/amp/
  5. http://wellness.allinahealth.org/library/content/0/10

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Self-care for your soles: stretching and massaging the feet

The dog days of summer are upon us, and for many of us that means our dogs are barking. Whether it’s long training runs or just running around town in flip-flops, summer activities can be hard on our feet. Feet are important - if your body was a house, the feet would be the foundation. Stiffness and pain in the feet can affect your stride, your posture, and even the long-term health of your knees and hips. Despite their importance, feet are all-too-often overlooked when it comes to our stretching and self-care routines. In this blog post, I will cover a number of ways to care for and protect our hard-working feet.

My foot care routine consists of three easy elements:

1.     Stretching the soles and tops of the feet

2.     Stretching the toes and mobilizing the ankles

3.     Rolling out the arches of the feet

 

Stretching the soles of the feet

This exercise calls for you to start on your hands and knees. Pad the knees with a folded blanket or towel, or do this exercise on a soft carpet.

Tuck your toes under so that the soles of your feet are pointed at the wall behind you.

Slowly and carefully sit back onto your heels, keeping the toes tucked. You should feel an intense stretch on the soles of the feet, and you may not be able to sit all the way up at first.

Take three deep breaths in this position, and then gently come back down onto hands and knees. Un-tuck your feet so that the tops of your feet are resting on the ground, and then sit up. This provides a stretch to the tops of the feet.

I recommend this stretch before and after a run, or just at the end of your day. It’s especially effective for anyone with plantar fasciitis and can be helpful as well for those with Achilles tendonitis or tight calves.

 

Stretching the toes and mobilizing the ankles

For this stretch, sit in a chair or on the floor with one foot crossed over the opposite knee. If you are sitting on the floor, you may want to sit on a folded blanket or towel to raise your seat up off the floor and protect your back.

Flex and spread the toes on your crossed-over foot, and then weave the fingers of your opposite hand in between your toes. This may feel like a stretch at first, especially if you wear close-toed shoes or heels regularly. Be patient and gentle, and only go as far as feels comfortable!

Use the hand that is grasping the foot to move the foot in circles at the ankle.Do five circles in one direction, and then reverse directions and do five more. You can give yourself a small massage while your hand is on your foot - I like to gently squeeze the toes, and to give some pressure to the spot on the inner arch of my foot.

Switch sides, and then you’re done! This stretch is super easy, but keeping the toes flexible and the ankles mobile is crucial for foot health and our overall stride and posture.

 

Rolling out the arches of the feet

Did you know that you can roll out your feet, the same way you might use a foam roller on your quads and back? All you need is a tool of the right size to fit your feet - some people use a tennis ball, a lacrosse ball, a special foot roller, or even a frozen water bottle! The frozen water bottle feels especially delicious after a long, hot run, and the cold helps to reduce swelling and pain.

So, there you have it! Three simple, easy practices to help you take care of the foundation of your body. You’re all set for a long walk on the beach (or your next half marathon)!

 

References

  1. http://www.shape.com/lifestyle/mind-and-body/must-do-foot-stretch-after-every-single-run
  2. http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/plantar-fasciitis/stretching-exercises-plantar-fasciitis
  3. http://www.ipfh.org/foot-care-essentials/why-preventive-foot-health-is-important

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Weight-lifter’s Shoulder (Distal Clavicular Osteolysis)

Weight-lifter’s shoulder, or Distal Clavicular Osteolysis, is a painful shoulder injury that occurs when the distal end of the Clavicle beings to deteriorate. As the body attempts to heal itself, the surrounding area can become inflamed and fibrosis (scar tissue) can form. Untreated, the condition can cause degeneration of the AC joint.

After reviewing the basic anatomy of the shoulder, going over possible causes for this injury and the symptoms that can be found, the treatment recommendations will be reviewed, including how massage, self-massage and stretching can be included in the recovery process.

Shoulder anatomy

The shoulder is composed of 3 bones:

  • The Clavicle (or Collarbone) goes from the Sternum (or Breastbone) to the shoulder
  • The Scapula (or Shoulder blade) includes the Acromion (most lateral part, can be felt when touching the outermost and superior part of the shoulder), the Glenoid cavity (articulates with the Humerus) and the Coracoid process (under the Clavicle)
  • The Humerus, or upper arm bone

Several joints are involved in a healthy shoulder:

  • The Glenohumeral joint, between the Glenoid cavity and the Head of the Humerus
  • The Acromioclavicular joint (or AC joint), between the Acromion and the distal end of the Clavicle
  • The Scapulothoracic joint, where the Scapula glides on top of the Thorax, in the back
  • The Sternoclavicular joint, between the Breastbone and the Collarbone.

For Distal Clavicular Osteolysis, the areas affected are usually the distal part of the Clavicle and the AC joint, but other surrounding structures can be affected by the inflammation too. 

Cause

The deterioration is generally due to repetitive stress on the shoulder. Stress can come from over training or improper training involving excessive pull on the Clavicle. For example, doing bench presses where the elbow drops below the body can put excessive strain on the Clavicle.

Symptoms

Weightlifter’s shoulder causes sharp pain in the area of the AC joint. The pain increases during movements that involve the joint (bench press, push-ups, power clean, …), the evening after training, or when sleeping on that shoulder. 

Treatment

Non-surgical options:

  • Rest from the activities that affect the bone and/or modification of weight training techniques gives more time to the bone to heal, and could help it regenerate itself. Modification recommendations by a physical therapist can include:
    • Narrowing hand spacing on barbells
    • Ending bench presses 2 inches above the chest
  • Icing helps decrease inflammation and provides pain relief.
  • Taking anti-inflammatories (as advised by a doctor) can help for pain management.
  • Massage therapy can help reduce hypertonic muscles that might be adding strain to the shoulder structures and can help reduce pain from muscle guarding.

If non-surgical options are not successful, surgery options may be offered.  

Massage therapy for symptom relief

During a massage therapy session, the focus will be on the muscles attaching to the anatomical structures presented above. By reducing areas of hypertonicity, the stress on the bony structures is reduced as well and discomfort from tight muscles is decreased. Tight areas can be found in the Pectorals, the neck muscles or in the upper back and can be treated with techniques such as deep tissue and stretching. These areas can also be addressed at home with self-massage techniques involving a massage ball and stretching: some commonly used techniques are illustrated below.

The techniques presented can be used outside the context of injury to prevent excessive tightness and maintain shoulder range of motion. Include them in your training regimen as needed.

As always, make sure to see your doctor if you suspect you have a shoulder injury and before attempting any self-care exercises. 

Related article: What Exactly Is a Rotator Cuff? article + video

Sources

  1. A Patient’s Guide to Weightlifter's Shoulder (Distal Clavicular Osteolysis), Houston Methodist (http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/shoulder/weightlifters-shoulder/)
  2. Sports and Exercise Massage, 2nd Edition, by Sandy Fritz
  3. Anatomie de l’appareil locomoteur, member supérieur, Michel Dufour
  4. Anatomy Trains, Thomas W. Myers
  5. The Roll Model, Jill Miller

Images

  1. Shoulder anatomy: http://www.eorthopod.com/images/ContentImages/shoulder/shoulder_cuff_tear_arthropathy/shoulder_cuff_tear_arthropathy_anat03.jpg
  2. image of weightlifter: http://us.myprotein.com/thezone/wp-content/uploads//2016/08/shoulder-pain-after-bench-press-1.jpg

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Assessing the Lower Half: Recognizing Muscular Imbalances Through Postural Assessments

Assessing someone’s posture could speak volumes. Proper postural alignment allows for optimal neuromuscular efficiency, which produces effective and safe movement. Good posture ensures the muscles of the body are in proper alignment and that there is proper absorption and distribution of forces throughout the kinetic chain. In other words, joint motion is happening the way it’s meant to, and less stress is being created. In general, when muscle imbalances are present, a certain muscle (or muscles) associated with a joint (or joints) may be in a shortened state while others are in a lengthened state, affecting the position of the joint and over time, create a cycle of injury, compensations and decreased mobility. When range of motion is lacking in certain joints, the body will try and find that range of motion somewhere else. In athletes who depend on core and lower body strength efficiency such as runners, any slight muscular imbalance could potentially lead to gait compensations, performance declinations, and injury later on. Other lifestyle factors to consider with muscular imbalances include past injuries, repetitive movements, extended periods of sitting, and occupational roles.

Though much could be said for assessing the head, neck, and shoulders, many athletes develop more lower body imbalances due to the constant loading and movement patterns required of them. Below are some basic static and dynamic tests that could be administered to detect any common postural distortion patterns including which muscles are either overactive (need to be released/stretched) or underactive (need to be strengthened) . Muscle groups that need to be strengthened should be addressed by the proper professionals such as a physical therapist or corrective exercise specialist, whereas overactive and tight areas will benefit most from frequent massage, stretching and foam rolling.

Static assessment side view

A. Lower Crossed Syndrome- anterior tilt of the pelvis (arched lower back)

  • Overactive Muscles: Hip Flexor Complex, Adductor Group (Groin Muscles), Latissimus Dorsi, Erector Spine
  • Underactive Muscles: Gluteus Maximus, Gluteus Medius, Transverse Abdominals

B. Proper alignment

Dynamic assessment front view: Overhead Squat

A. Pronation Distortion Syndrome- foot pronation (flat feet) and internally rotated knees (knee valgus)

  • Overactive Muscles: Gastrocnemius/Soleus (Calf Muscles), Peroneals, Adductors, TFL, Hip Flexor Complex
  • Underactive Muscles: Anterior Tibialis, Posterior Tibialis, Gluteus Maximus, Gluteus Medius

B. Proper alignment

Dynamic assessment side view: Overhead Squat

A. Excessive Forward Lean- tightness in the hip flexors and posterior legs cause weight to be shifted forward

  • Overactive Muscles: Gastrocnemius/Soleus (Calf Muscles), Hip Flexor Complex, Abdominals
  • Underactive Muscles: Anterior Tibialis, Gluteus Maximus, Erector Spine

B. Proper alignment

Full Range Of Motion (Or Are Your Joints Flexible Enough?)

Full range of motion is an integral factor in optimal performance. Studies have shown that performing exercises with full ROM is more beneficial for long term strength than performing the same exercises with a shortened ROM. Increased passive flexibility in joints has also been shown to delay the onset of arthritis, as well as reduce symptoms.

Each muscle group works in tandem to produce joint movements.  You have the agonist (performer of an action), antagonist (opposite muscle group, and stabilizer muscles) they stabilize the joint while it’s moving).   Imagine your running stride; your leg moves forward, your foot hits the ground, and you use that foot to launch your body forward. The first joint movement in this action is called hip flexion. Your hip flexors (the agonists) will lift your thigh forward and up, so that you can plant your foot forward. If the antagonist group (the hamstrings) has a pathologically shortened ROM, your hip flexors will not be strong enough to overpower them, and you will have a short stride. In order to prevent this, you will need to check your hamstring ROM and treat them accordingly. You can apply this thinking to any movement or exercise; your bench press, squat, deadlift, running, jumping, and throwing. There is always an agonist, and antagonist. Each group will need to utilize full ROM in order to perform optimally.

Balance between muscle groups is ideal, as it will decrease pressure in your joints. Each joint is surrounded by soft tissue. This can be muscle tissue, fascia, tendons and ligaments. If this tissue is tight, it will pull the joint into itself and, eventually, wear down the cartilage and synovial fluid. Over time, this can cause two bones to grind, which can lead to arthritis.  Keeping this surrounding tissue loose and soft will help prolong the health of your joints.

Each joint has a normal, ideal range of motion. Anything less than this normal range is termed “hypomobility” and will eventually cause some problems. Anything significantly higher than this normal range is termed “hypermobility” and will also, eventually, cause some problems. You’ll want to regularly test your ROM and keep each joint near this ideal range.  If you have some hypomobility in a certain movement, you will want to soften and loosen the antagonist group. If there is hypermobility in a movement, then you will want to strengthen and tighten the antagonist muscle group. Again, we just want a healthy balance between the groups.

Below is a somewhat comprehensive list of some main joints and movements. You will see what the ideal ROM is, as well as the antagonist and agonist for each movement. You can use this information as a comparison to your own ROM. Have a friend take a picture of you. You can then draw a line with a protractor and see how you match up!

Normal ROM (in degrees)

Hip and Leg

Hip

1.    Flexion 0-125

Agonists: Hip flexor group - Iliopsoas, TFL, Rectus Femoris, Pectineus, Sartorius.

Antagonists: Hamstrings, Gluteus Medius, Gluteus Maximus.

2.    Extension 0-30

Agonists: Hamstrings, Gluteus Medius, Gluteus Maximus.

Antagonists: Hip Flexor Group - Iliopsoas, TFL, Rectus Femoris, Pectineus, Sartorius.

3.    Adduction 45-0

Agonists: Adductor group - Pectineus, Adductor Brevis, Adductor Longus, Gracilis, Adductor Magnus.

Antagonists: Gluteus Minimus, Gluteus Maximus, Gluteus Medius, TFL.

4.    Abduction 0-45

Agonists: Gluteus Minimus, Gluteus Maximus, Gluteus Medius, TFL.

Antagonists: Adductor group - Pectineus, Adductor Brevis, Adductor Longus, Gracilis, Adductor Magnus.

5.    Medial (internal) rotation 0-45

Agonists: Adductor group, TFL.

Antagonists: Lateral rotator group - Piriformis, Gemellus Superior And Inferior, Obturator Internus And Externus, Quadratus Femoris. Iliopsoas.

6.    Lateral (external) rotation 0-45

Agonists: Lateral rotator group - Piriformis, Gemellus Superior And Inferior, Obturator Internus And Externus, Quadratus Femoris. Iliopsoas.

Antagonists: Adductor group, TFL.

Knee

1.    Flexion 0-130

Agonists: Hamstrings, Gastrocnemius.

Antagonists: Quads.

2.    Extension 0

Agonists: Quads

Antagonists: Hamstrings, Gastrocnemius.

Ankle

1.    Plantar flexion 0-50

Agonists: Gastrocnemius, Soleus.

Antagonists: Tibialis Anterior.

2.    Dorsiflexion 0-20

Agonist: Tibialis Anterior.

Antagonists: Gastrocnemius, Soleus.

3.    Inversion (supination) 0-35

Agonists: Tibialis Anterior, Tibialis Posterior.

Antagonists: Peroneus Longus, Peroneus Brevis, Peroneus Tertius.

4.    Eversion (pronation) 0-25

Agonists: Peroneus Longus, Peroneus Brevis, Peroneus Tertius.

Antagonists: Tibialis Anterior, Tibialis Posterior.

Shoulder and Arm

Shoulder

1.    Flexion 0-90

Agonists: Anterior Deltoid, Clavicular Head Of Pectoralis Major, Long Head Of Biceps.

Antagonists: Latissimus Dorsi, Teres Major, Posterior Deltoid, Long Head Of Triceps.

2.    Extension 0-50

Agonists: Latissumus Dorsi, Teres Major, Posterior Deltoid, Long Head Of Triceps.

Antagonists: Anterior Deltoid, Clavicular Head Of Pectoralis Major, Long Head Of Biceps.

3.    Abduction 0-90

Agonists: Deltoid, Supraspinatus.

Antagonists: Latissumus Dorsi, Teres Major, Pectoralis Major.

4.    Adduction 90-0

Agonists: Latissimus Dorsi, Teres Major, Pectoralis Major.

Antagonists: Deltoid, Supraspinatus.

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5.    Lateral (external) rotation 0-90

Agonists: Posterior Deltoid, Infraspinatus, Teres Minor.

Antagonists: Latissimus Dorsi, Teres Major, Subscapularis, Anterior Deltoid.

6.    Medial (internal) rotation 0-90

Agonists: Latissimus Dorsi, Teres Major, Subscapularis, Anterior Deltoid.

Antagonists: Posterior Deltoid, Infraspinatus, Teres Minor.

Elbow

1.    Flexion 0-160

Agonists: Brachialis, Biceps, Brachioradialis.

Antagonists: Triceps, Anconeus.

2.    Extension 0

Agonists: Triceps, Anconeus.

Antagonists: Brachialis, Biceps, Brachioradialis.

3.    Pronation 0-90

Agonists: Brachioradialis, Pronator Teres, Pronator Quadratus.

Antagonists: Biceps, Supinator, Brachioradialis.

4.    Supination 0-90

Agonists: Biceps, Supinator, Brachioradialis.

Antagonists: Brachioradialis, Pronator Teres, Pronator Quadratus.

Wrist

1.    Flexion 0-90

Agonists: Wrist flexor group.

Antagonists: Wrist extensor group.

2.    Extension 0-70

Agonists: Wrist extensor group.

Antagonists: Wrist flexor group.

3.    Adduction 0-65

Agonists: Extensor Carpi Ulnaris, Flexor Carpi Ulnaris.

Antagonists: Extensor Carpi Radialis Longus, Flexor Carpi Radialis, Abductor Pollicis Longus.

4.    Abduction 0-25

Agonists: Extensor Carpi Radialis Longus, Flexor Carpi Radialis, Abductor Pollicis Longus.

Antagonists: : Extensor Carpi Ulnaris, Flexor Carpi Ulnaris.

Neck and Spine

Neck

1.    Flexion 0-90

Agonists: Sternocleidomastoid, Scalenes, Longus Capitis, Longus Colli.

Antagonists: Upper Trapezius, Levator Scapula, Splenius Capitis, Splenius Cervicis.

2.    Extension 0-55

Agonists: Sternocleidomastoid, scalenes, longus capitis, longus colli.

Antagonists: Upper Trapezius, Levator Scapula, Splenius Capitis, Splenius Cervicis.

3.    Rotation (right and left) 70

Agonists: Upper Trapezius, Scalenes, Levator Scapula.

Antagonists: Contralateral Upper Trapezius, Scalenes, Levator Scapula.

4.    Lateral flexion 35

Agonists: Sternocleidomastoid Upper Trapezius, Scalenes, Levator Scapula.

Antagonists: Contralateral Sternocleidomastoid Upper Trapezius, Scalenes, Levator Scapula.

Spine

1.    Flexion 75

Agonists: Rectus Abdominus, Internal And External Obliques, Quadratus Lumborum.

Antagonists: Spinalis, Iliocostalis, Longissimus

2.    Extension 30

Agonists: Spinalis, Iliocostalis, Longissimus

Antagonists: Rectus Abdominus, Internal And External Obliques, Quadratus Lumborum.

References:

  1. "Physical Activity for Arthritis." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 18 Apr. 2017. Web. 25 Apr. 2017, from https://www.cdc.gov/arthritis/basics/physical-activity-overview.html
  2. "Normal Ranges of Joint Motion." STRETCHING AND FLEXIBILITY - Normal Ranges of Joint Motion. N.p., n.d. Web. 25 Apr. 2017, from http://web.mit.edu/tkd/stretch/stretching_8.html
  3. “Joint Range of Motion Testing” (n.d.). Retrieved April 25, 2017, from http://www.exrx.net/Testing/JointROM.html
  4. "Impact of Range of Motion During Ecologically Valid Resistance Training Protocols on Muscle Size, Subcutaneous Fat, and Strength", McMahon, Gerard E.1,2; Morse, Christopher I.1; Burden, Adrian1; Winwood, Keith1; Onambélé, Gladys L.1. Retrieved 26 April, 2017, from http://journals.lww.com/nsca-jscr/Citation/2014/01000/Impact_of_Range_of_Motion_During_Ecologically.32.aspx
  5. Fritz, Sandy . Sports & Exercise MassageComprehensive Care in Athletics, Fitness, & Rehabilitation. Elsevier Health Sciences, 2012. 
  6. Trail Guide to the BodyA Hands-On Guide to Locating Muscles, Bones and More. 2015. 
  7. W.Lowe, Whitney . Orthopedic MassageTheory and Technique. Elsevier Health Sciences, 2009. 
  8. G.Salvo, Susan. Massage TherapyPrinciples and Practice. Elsevier Health Sciences, 2015. 

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician

Back Muscles: Structure, Strengthening and Stretching

Almost everybody has experienced back pain or tightness at one time or another.  Limited flexibility, chronic aches and time lost from work are some of the consequences of this ailment.  We strive to stay ahead of this disabling situation, but we are affected by it for a variety of reasons.    They may include weak muscles, muscular imbalance, over-exertion and fatigue. Our posture, range of movement and even our moods are affected by these limitations.  We will discuss the structure of the whole back muscles, both anatomically and functionally, though our focus will be on the mid and lower back. We will then provide a series of exercises for both strengthening and stretching the back muscles as a preventative measure for the future. These exercises are generally recommended, but please make sure to check with your physician before attempting them.

Structure

The back muscles are designed to direct various movements of the back (upper, mid and lower back), shoulders, neck and arms, provide protection of the spine and maintain an erect posture.  They can be divided into three groups, based on their location and associated movements. The Superficial group is located along the mid to upper back and include the Latissimus Dorsi, Trapezius, Levator Scapulae and Rhomboids (Major and Minor).  Their functions involve movements of the shoulders, scapula, arms and neck.  They can be viewed in Figure 1.  The Intermediate group includes the Serratus Posterior (Superior and Inferior).  They are associated with the movements of the rib cage.  The Deep group includes the Iliocostalis, Longissimus and Spinalis, collectively known as the Erector Spinae.  They are the longest muscles in the back and run parallel and on each side of the spine (from the sacrum to the cervical portion of the vertebrae). The Spinalis lies medial to the Longissimus and the Iliocostalis is the most lateral of the three muscles.  An illustration is provided in Figure 2. The function of the Erector Spinae is to extend, flex and laterally flex the vertebral column. Back pain tends to be located in the lower back region and these muscles need to be highlighted for strengthening and stretching  purposes.  

Fig. 1

Fig. 1

Fig. 2

Fig. 2

Strengthening exercises

A series of two strengthening exercises provided below illustrates some easy weight lifting or core strengthening movements.

Reverse Fly

Stand tall with feet shoulder width apart, back straight with knees slightly bent.  Hold a five to eight pound dumbbell in each hand, palms facing in and hinge forward at the waist.  Bend elbows slightly and raise the weights out to the side, as far as you can.  Return to starting position and repeat 2 sets of 16 reps. (Fig. 3)

Fig. 3

Fig. 3

Opposite Arm and Leg Reach

Start on your hands and knees.  Reach your right hand forward while, at the same time stretching your left leg backward (and toes flexed).  Hold for 5 seconds then release and repeat using the opposing arm and leg.  Repeat this sequence 10 times. (Fig. 4)

Fig. 4

Fig. 4

Stretching exercises

Knee to Chest

Intended to stretch the lower back and glutes.  Lie flat on your back and slowly bend your right knee, pulling your leg to your chest. Wrap your hands around your knee, holding that position for 20 seconds.  Return your leg to the starting position and repeat the sequence for each leg. (Fig. 5)

Fig. 5

Fig. 5

Lumbar Traverse

This exercise is intended to stretch the Paraspinal muscles.  Lie flat on your back with legs extended.  Bend your right knee and cross it over the left side of your body.  Hold that pose for 20 seconds and return to starting position.  Repeat this sequence for each leg 3 times. (Fig. 6)

Fig. 6

Fig. 6

Child’s Pose

This is a restful common pose in Yoga, meant to relax and decompress the lower back.  Position yourself on the floor on your hands and knees, with knees splayed outward (wider than hip distance apart).  Turn your feet inwards to touch and push your hips backward resting them on your heels.  Extend your arms forward and allow your head to fall forward in a relaxed manner.  Hold for 20 seconds and then return to starting position.  Repeat this sequence 3 times.  (Fig. 7)

Fig. 7

Fig. 7

A regular routine of strengthening and stretching of the lower back muscles can help avoid back injury or alleviate the pain when it occurs.  It should not be a debilitating condition, though it is quite common.  Massage is a valuable resource to help in relieving hypertonic muscles, decrease pain and discomfort and also increase range of motion.  A massage session will often incorporate some of the stretches listed above, if applicable for your needs.  A massage therapist can assist you, to supplement the measures you may have already undertaken.

References:

  • Fig. 1: http://teachmeanatomy.info/back/muscles/superficial/ (viewed 4/3/17)
  • Fig. 2: https://www.pinterest.com/pin/343047696587939838/ (viewed 4/3/17)
  • Fig. 3: http://www.health.com/health/gallery/0,,20709957,00.html#reverse-fly-0 (viewed 4/12/17)
  • Fig. 4: http://www.health.com/health/gallery/0,,20709957,00.html#opposite-arm-and-leg-reach-0 (viewed 4/12/17)
  • Fig. 5, 6 & 7: http://www.apmhealth.com/education/healthy-living/stretching---strengthening-tips/6-stretches-to-help-back-pain (viewed 4/12/17)
  • http://teachmeanatomy.info/back/muscles/intrinsic/ (viewed 4/3/17)
  • http://anatomy.uams.edu/introback.html (viewed 4/12/17)
  • http://www.mayoclinic.org/diseases-conditions/back-pain/basics/prevention/con-20020797 (viewed 4/12/17)
  • http://anatomyzone.com/tutorials/musculoskeletal/extrinsic-muscles-of-the-back/ (viewed 4/12/17)
  • http://www.kingofthegym.com/back-anatomy (viewed 4/3/17)
  • http://www.spine-health.com/wellness/exercise/stretching-back-pain-relief (viewed 4/12/17)
  • http://www.sport-fitness-advisor.com/muscular-system-diagram.html (viewed 4/12/17)

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Active Isolated Stretching (AIS)

Active Isolated Stretching is a stretching technique used by professional athletes and fitness coaches to increase flexibility and treat injuries.

Definition:

“Active”

The movement is initiated by the athlete then deepened by the therapist, to go beyond what the athlete would normally do on their own. The active participation favors muscle awareness and relaxation for more efficiency.

“Isolated”

Stretches isolate specific muscles for more precise work than general stretching (for example, there are 6 different stretches for the 6 muscles that comprise the hamstrings).

“Stretching”

The stretch allows for increased range of motion by lengthening muscles, fascia and increasing joint mobility.

Watch a slideshow of AIS.

How it works:

Stretches are held no more than 2 seconds, and repeated up to 10 times. After a session, the therapist teaches specific stretches for home self-care.

Benefits:

Stretching has many benefits:

  • Increases range of motion in those muscles that need more mobility thus reducing the risk of injury
  • Participates in the reduction of knots and muscle tightness, also reducing risks of injury
  • Provides more mobility, comfort and better posture, reduces asymmetries.

Watch our testimonial of a client who was helped in treating his IT Band syndrome with AIS.

All of our therapists have basic training in AIS and Nick is our certified AIS therapist – ask us about incorporating AIS to your next massage session. 

At the end of an AIS session, your therapist will demonstrate self-massage techniques to use at home to continue benefiting from the technique. 

Watch a hamstring self-stretching sequence with AIS

Achilles tendonitis

One of the largest and strongest tendons in the body is the Calcaneal tendon, better known as the Achilles tendon.  This tendon is responsible for helping you walk to work, run those long runs, and jump with during that HIIT workout. When you stand up on your toes or push off, this is the tendon that allows you to do so. It attaches from your calf muscles (Gastrocnemius and Soleus) to your heel (calcaneal bone) and is one hardworking tendon: when you flex your calf, it pulls on your heel. [1]Overuse, poor self-care leading to tight muscles, poor shoe choices (not enough support, old, too high…), excessive incline workouts, increasing running mileage or the intensity of your workout too quickly are some of the things that can lead to pain and injury to the Achilles tendon. If left untreated, it can turn into what is known as Achilles tendonitis or tendinopathy. Symptoms of this injury are pain, swelling and inflammation in the back of the heel or lower calf; there may also be limited flexibility in the ankle. This can be felt especially in the morning when first walking, but can be present throughout the day with varying degrees of pain and discomfort.

If these symptoms start and don’t dissipate, stop your workouts immediately. Any activity that aggravates your symptoms should be put on hold until this injury subsides. Until you can complete toe raises without pain, don’t resume intense activities. The RICE method is recommended (Rest, Ice, Compression and Elevation) right after the injury occurs. Your doctor will generally recommend Ibuprofen to reduce the pain and inflammation. Splints and or taping can also be beneficial. A visit to the doctor for proper diagnosis is also important.

Once through the initial acute phase, low impact activities such as the elliptical, swimming and biking can help resume activities without being too stressful on the lower leg. Gentle stretching, foam rolling and massage of the calves are great ways to loosen the muscles in the lower legs and reduce the stress on the Achilles tendon.

Some stretches that have been shown to be beneficial are eccentric heel drop, Soleus stretch and Gastrocnemius stretch, shown below.

Eccentric heel drop:

[2]Stand on the edge of a step and lower yourself slowly and in control (try a slow count of 4 or 5) on your injured foot, essentially exerting force as the muscle extends.

Then use your other, non-injured, foot to raise yourself back up, so as not to stress the tendon in the rising motion.

Do 15 repetitions, twice a day.

 

[3]Soleus stretch

With your knees bent, and the leg that needs to be streched behind gently lean forward while keeping the rear heel down.

Do 15 repetitions, hold each for 15-20 seconds.  Repeat twice a day.

Gastrocnemius stretch

[3]With straight legs and the leg that needs to be stretched behind, gently lean forward while keeping the heel down.

Do 15 repetitions, hold for 15-20 seconds each.  Repeat twice a day.

 

 

 

If these methods don’t alleviate the problem, your doctor can recommend the next steps.  Self-care should be an important part of every person’s routine, especially athletes.  With proper self-care of your lower legs, stretching, listening to your body, foam rolling and massage, you can aim to stay healthy and injury free.

 

Picture references:

  1. http://strengthrunning.com/2013/03/achilles-tendonitis/
  2. http://www.runnersworld.co.za/training/cross-training/dont-get-hurt-build-strength/
  3. http://astepahead.com.au/cooling-down-and-stretching-for-netball/

References (viewed 2/27/17):

  1. http://www.healthline.com/health/achilles-tendinitis
  2. http://orthoinfo.aaos.org/topic.cfm?topic=a00147
  3. http://www.runnersworld.com/achilles-tendinitis
  4. http://www.sportsinjuryclinic.net/sport-injuries/ankle-achilles-shin-pain/achilles-tendonitis
  5. http://www.webmd.com/fitness-exercise/picture-of-the-achilles-tendon#1

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Sinus Inflammation and Massage

This time of year we are exposed to all sorts of nasties, which can leave our sinuses in overdrive. Changes in temperature, environmental allergies and illnesses can all contribute to sinus inflammation. If you are one who suffers from sinus inflammation, you will know that it can be difficult to function normally when symptoms rear their ugly heads! Sinuses are air-filled sacs that clean the air that we breathe through the nose. They lighten the bones of the skill, and provide shape to the face. Allergies, infections and physical obstructions can cause the sinuses become inflamed or swollen. (1)

Structure

There are four sinus points located above, either side of, and behind the nose. The sinuses are named after the bones of the skull in which they are located (2).

image [2]Frontal Sinuses: located on the center of the forehead above the brow-line of each eye, on the frontal bone

Ethmoid Sinuses: small air sacs located on either side of the bridge of the nose. The Ethmoid bone separates the nasal cavity from the brain

Sphenoid Sinuses: located deep to the nose, near the optic nerve on the Sphenoid bone

Maxillary Sinuses: located behind the cheekbones near the Maxilla or upper jaw

image [1] 

Causes of sinus inflammation

  • Viruses, bacteria and fungi: cold or flu
  • Structural problems: deviated septum, nasal polyps can obstruct the flow of mucus and block drainage (3)
  • Environmental irritants: indoor and outdoor pollutants, grasses and pollens, certain foods

Symptoms

  • Headaches
  • Tenderness in the affected area
  • Swelling and puffiness around the eyes
  • Runny or congested nose
  • Facial or tooth pain
  • Fatigue

Massage

When inflammation occurs, pain may also be present in the surrounding muscles of the face, the upper neck and the jaw. In structural and environmental cases of sinus inflammation, gentle massage around the face and neck will help to drain the sinuses and relieve pressure from the affected areas.

If a fever and infection is present, massage can exasperate symptoms. In this case it is best to wait until the fever has passed before bodywork is performed. (1)

See our article on ‘Cold, Flu and Massage’.

Self care massage for sinus relief

  1. Set yourself up in a comfortable position, preferably supporting your head and neck.
  2. Spread your fingers wide, place your fingers and thumbs around your scalp line and gently move your fingers in small circles
  3. Have your fingers meet in the center of your forehead, slowly drag your fingertips towards each ear (frontal sinus)
  4. Take your index or middle finger and slowly draw small circles along your eyebrow line, starting from your nose and gently migrating laterally towards each ear (frontal sinus)
  5. Bring your middle fingers back to the bridge of your nose. Find two little nodules, where your nasal bone meets the frontal bone. Hold a firm pressure for 10-15 seconds. (Ethmoid sinus)
  6. Move your fingers back to the bridge of your nose. This time, drag your fingers down each side of your nose (sphenoid sinus)
  7. Take a flat finger on either side of your nose, and gently drag along each cheek bone towards your ears (maxillary sinus)
  8. Small circles on the temporalis, (clench the jaw to locate the temporalis muscle)
  9. Firm pressure on the temporalis, slowly push your fingers away from your face (towards the back of your head) as you slowly open your mouth
  10. Small circles around the ear, (TMJ, Coracoid process and temporalis tendon)
  11. Gently pull your ears for a temporalis release

References:

  1. A Massage Therapist’s Guide to Pathology Ruth Werner LMP, NCTMB, fifth edition, pg. 332
  2. http://www.healthline.com/human-body-maps/sinus-cavities
  3. A Massage Therapist’s Guide to Pathology Ruth Werner LMP, NCTMB, fifth edition, pg. 333

Images:

  1. http://philschatz.com/anatomy-book/contents/m46355.html
  2. http://www.rugusavay.com/information-on-skull-anatomy-and-functions/

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Changes to your membership, March 1st, 2017

Dear Members, Phila Massages has been in business now since 2010 and we are grateful to have been growing ever since. To align with the increasing cost of business and in order to continue providing the top quality sports massage that you enjoy, our rates will increase for the first time since introducing our membership system. The changes listed will take place March 1st, 2017.

At Phila Massages, we always put our members first. While our overall rates are changing, we plan to implement two great promotions. First, the rates at our Manayunk location will be discounted by $10 throughout 2017 (making the rates there the same or even lower than in 2016!). Our second discount is to reduce our PTSM rate so that more of you can enjoy it (if you haven’t already, try it out this year!).

We are excited to promote out calls for athletes and athletic teams in the Philly area; we have been doing out calls since we opened but we are now promoting this service as our expanded team is able to be more mobile. The number of member guest passes will increase so that you can benefit from one for each membership month; they will no longer be member rate but 25% off for family or friends.

Additionally, over the winter we will be sprucing up our Rittenhouse location and transitioning into a new logo – look out for those exciting changes!

We understand that this is a modification of your current membership, so if you wish to cancel your membership, you can do so at no charge or with a pro-rated refund between now and February 28th, 2017. To do so, simply email contact@philamassages.com.

As of now, we have a fantastic team of 12 massage therapists all dedicated to their sports massage career and helping you in your athletic goals; we look forward to working with you this year!

Natacha

 

 

  

If you have any questions about these changes, please don't hesitate to email us: contact@philamassages.com.

Take a deep breath and improve your athletic performance

Do you want to shorten recovery time, increase stamina, decrease stress, sharpen your focus, and improve your athletic performance? Take a deep breath and read on! As athletes, the importance of breathing is often overlooked. After all, everyone breathes all day every day, so why think about it? This blog post will explore some breathing techniques to help elevate performance, discuss the benefits that one can obtain by using those techniques and how massage can participate in more efficient breathing.

Recent studies have shown diaphragmatic and nasal breathing techniques could improve athletic performance. Diaphragmatic breathing may increase the antioxidant defense status in athletes after exhaustive exercise [1], activate the parasympathetic nervous system to calm nerves, decrease stress and muscle tension [2], sharpen focus, reduce fatigue, and promote stamina [3]. Nasal breathing on the other hand allows the body to take in and process oxygen 20% more efficiently during exercise and protects the lungs from cold and polluted air. For athletes specifically, these two techniques could increase physical performance, focus, mental performance and shorten recovery time [4]. In the video below we will teach you these two techniques so you can improve your breathing and athletic performance.

So where does massage come into play when it comes to breathing? Most people know that the lungs allow us to breathe but don’t usually think about the muscles that allow the lungs to function. The diaphragm is the main muscle that allows humans to inhale (inspiratory) and the abdominal muscles primarily allow humans to exhale (expiratory). A number of smaller muscles also assist in breathing as seen in the diagram below. Any restrictions we have in these muscles can impede breathing and thus harm athletic performance and recovery. Asking your massage therapist to incorporate techniques that target these muscles in your sessions can help to remove those restrictions and allow more effective and efficient breathing for improved performance.

[11]Want more information on massage for the diaphragm and abdominal muscles?

 

References:

  1. http://triathletetraining.com/tt070-mobility-for-faster-performance-alexander-technique-nasal-breathing-wgeorge-dallam/
  2. http://www.active.com/fitness/Articles/Breathing-Techniques-to-Improve-Your-Performance
  3. https://www.hindawi.com/journals/ecam/2011/932430/abs/
  4. http://online.liebertpub.com/doi/abs/10.1089/acm.2010.0666
  5. http://triathletetraining.com/triathlete-training-podcast-episode-4/
  6. http://www.bigwheelcoaching.com/deep-breathing-for-endurance-athletes-better-performance-through-breath/
  7. https://www.youtube.com/watch?v=o8IKOFoigV4
  8. http://www.webmd.com/balance/stress-management/breathing-with-your-diaphragm
  9. http://www.marksdailyapple.com/how-to-breathe-correctly/
  10. http://www.breathing.com/articles/nose-breathing.htm
  11. https://goo.gl/images/hInp0g

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

 

 

The Importance of SI Joint Function

What is the SI Joint? The sacroiliac joint or SI joint is the joint that connects the sacrum with the pelvis and is located on each side of the lower spine.

Ref. 1

The SI joint’s main job is shock absorption.  It does this by transferring the forces of the upper body to the lower body, which includes the hips.  This is a very stable joint due to its anatomical configuration and strong ligaments. There are also strong muscles surrounding or reinforcing the joint such as erector spinae, psoas, quadratus lumborum, piriformis, abdominal obliques, gluteal muscles, and hamstrings which all make it even more stable.  

Despite being so stable the SI joint is in fact a mobile joint, though minimally, which allows it to perform proper shock absorption during weight-bearing activities and motions.  We will get to this in a moment.

Why Is This Joint So Important?

The most pivotal responsibility of the SI joint is to limit stress and force between the hip and lumbar spine.  It does this by anatomical configuration and its shear strength.  This comes to play in many daily situations such as standing, walking, sitting, lifting heavy objects, or exercises such as performing squats and jumping activities.  

SI Joint Dysfunction

Now that you have learned a little about the SI joint and its significance, it is just as important to know what happens when it is not functioning properly.  

SI joint dysfunction is one of the leading causes of low back pain.  It is often hard to diagnose initially because the symptoms are similar to sciatica or lumbar disc herniation, but it is usually found during  physical examination that includes movements.  Inflammation at the joints is also common in SI joint dysfunction.  The causes of SI joint dysfunction, however, are varied but fall into the category of hypermobility (instability) or hypomobility (stiffness).  This goes back to an earlier point, which is in order for proper shock absorption, the joint needs to stay mobile but can not become overly mobile to the point of instability.  

Symptoms include: pain on one side (more common) or both sides of the body, pain in the lower back and/or hip, pain in the thigh and/or glute, pain that radiates down the sciatic nerve (similar to sciatica), groin pain, and is most common among young and middle-aged women.  It can cause painful sitting and difficulty getting out of bed or car without experiencing pain.

How to Prevent or Treat Dysfunction

In order to prevent SI joint dysfunction from occurring, it is important to know the causes of instability or stiffness.  In most cases, the cause is due to muscle imbalances.  These muscle imbalances can include weak glutes, hips, hamstrings, core, and lats.  Not only is hip strength and stability  important, but also mobility.  Other causes are poor posture such as leaning more to one side, running which creates a repetitive pounding on the joint, repetitive or violent twisting motions, and pregnancy due to hormones being released in the body that cause your joints to become more mobile and loose.  If chronic back pain occurs it is always important to find the cause and location before any specific treatment is to be performed.  

Now that you know you have SI joint dysfunction, how do you fix it?  The combination of massage, stretching, and exercise techniques are effective ways to treat this.  The role of a licensed massage therapist would be to increase mobility in the areas of tightness that are causing the SI joint to become stiff, one of the two main causes of SI joint dysfunction.  They would be targeting the  imbalanced muscles previously talked about while also increasing blood flow to the joint to promote healing.  Your LMT may also recommend stretching for self care in conjunction to your sessions.  Here are two examples of stretches:

1 - Prone on elbows 

With this stretch you want to make sure your elbows are aligned with your shoulders and tilt up with your palms until you feel it in your lower back

fullsizerender

2 -single knee chest stretch

With this stretch you simply want to extend the opposite leg and bring the other leg to your chest and hold.  You could also use shorter holds and alternate which turns this into more of an exercise/dynamic stretch.

img_1898

 

If you have never had SI joint dysfunction or have had it and do not want a relapse, adding strength training to your massage and stretching routine is key. The 3 areas that you would focus on are:

1 - Glute strengthening and activation exercises (see Ref. 2 for an example)

2 - Hip strengthening exercises (see Ref. 3 for an example - Make sure your back stays straight and head and feet are facing forward) 

3- Core strengthening exercises. A good example is a forearm plank (see Ref. 4); although basic, it is a very effective exercise to strengthen your core. Make sure you are contracting your abs and lifting from the toes. Hold for about 60 seconds or as long as you can during each rep. 

There are also several other exercises that you can do at home to address the SI joint.  See Ref. 5 for a video demonstrating 3 common exercises.

Lastly, use proper posture and focus on sitting properly, making sure in particular that you are not leaning on one side more than the other, and practice self-awareness.

 

References (retrieved 10/28/16):

  1. http://www.blackchiropractic.com.au/chiropractic/sacroiliac-joint-pain/
  2. https://youtu.be/rrZRGk2YeWM
  3. https://youtu.be/_OQi0XkgZss
  4. https://s-media-cache-ak0.pinimg.com/564x/6c/9f/d3/6c9fd3dd4a6e9f55eb7b806fa150717a.jpg
  5. https://www.youtube.com/watch?v=CXH5SEI_AsM
  6. https://breakingmuscle.com/mobility-recovery/why-your-si-joint-is-such-a-pain-and-4-exercises-to-fix-it-0
  7. http://www.spine-health.com/conditions/spine-anatomy/sacroiliac-joint-anatomy
  8. http://www.spine-health.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-dysfunction-si-joint-pain
  9. http://www.webmd.com/back-pain/si-joint-back-pain
  10. http://www.stack.com/a/7-exercises-to-build-complete-hip-strength

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Runners keep your BALANCE in check!

If you are a runner and are work with me, you may notice me asking you many questions during our session.  This is because I want to be sure you are doing everything possible to prevent muscular imbalance and injury.  It seems runners just want to run, however, let’s face it, you must do your homework as well.  Balance and lower leg/foot strength ( along with massage and foam rolling) are some of the key ingredients to improving AND keeping muscle tissue healthy.  Runners who have an impaired sense of balance are at an increased risk of injury by tripping and falling, says Kevin McGuinness at Washington Orthopedics & Sports Medicine.  If you have an impaired sense of balance or compensation due to overuse it may cause injury. If you are having issues simply balancing on one leg while just standing, imagine how much more difficult it is on your body while bounding from one leg to the next! Need to be further convinced to improve your balance?  Here are 4 reasons:

  1. Who doesn't want Herculean ankle strength?!
  2. It will also improve your sense of awareness and proprioception.
  3. It will improve your single leg balance (aka run).
  4. This does not require much equipment, if any.

Some ideas for strengthening feet for balance:

  1. Ditch your shoes. Start by walking around your house barefoot, and once you gain strength there then work your way up to some barefoot exercises.
  2. Running in sand to work through joint articulation in the feet and increase strength and flexibility.
  3. Walking on rocks. This will get the proprioceptive nerves in your feet going and will help prevent back pain.
  4. Roll out the three arches of your foot. You can use a lacrosse ball frozen water bottle etc. Here be sure to include your lateral (outside) arch, transverse (center) arch, and medial (inside) arch. You will most likely feel pain in your transverse arch taking extra care when you move close to the heel as this area may be very sensitive.
  5. Use balance boards, bands and balance trainers. The picture below is an example of an exercise I recommend frequently to my running clients for muscular balance in the lower leg. You may also place your ankles on a foam roller or a throw pillow to lift your heels off of the ground.  Attach the other end of the band to heavy furniture or weights or have someone stand on it.

ref. 5

Since running involves dynamic movement it makes sense for us to improve our dynamic balance training.  Check out these videos below for some examples of dynamic balance training that requires absolutely no equipment:

    1. This exercise may prove to be tougher than it looks for some.  Try to keep control on one leg and stabilize the foot, ankle, knee and hip while drawing the letters of the alphabet A all the way through Z by dynamically moving the arms.

  1. If you have mastered the previous exercise then you may want to attempt the single leg “hop and “hold” for more difficult single leg dynamic stability.

You will find that this article will provide you with many additional ideas for exercises to improve run strength.  This includes improving optimal power, core strength, lateral movement, upper body strength, leg strength, stabilization and posture.

Focusing on some of the exercises presented above a few times per week in addition to your runs will aid in injury prevention, keep muscle tissue healthy and will even improve overall strength and the quality of your runs. If you are looking for any additional ideas for balance exercises I am happy to share more of them with you during our next massage therapy session.  Stay balanced!!!

 

References (Retrieved 10/4/16)

  1. http://greatist.com/move/balance-training-for-runners
  2. http://www.runningshoesguru.com/2014/05/dynamic-balance-training-for-runners/
  3. https://www.washingtonpost.com/lifestyle/wellness/why-balance-can-make-or-break-a-runner/2016/03/23/4a9df378-ec69-11e5-b0fd-073d5930a7b7_story.html
  4. http://www.bodybuilding.com/fun/strength-training-for-runners-how-to-do-it-right.html
  5. https://breakingmuscle.com/strength-conditioning/5-foot-strengthening-exercises-to-improve-speed-power-and-balance

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Two Minutes A Day For A Healthier Spine

Spinal hygiene is often compared to dental hygiene. Similar to teeth, the spine can develop disorders and deteriorate. The  only difference is that if there is dysfunction or decay, it is more difficult to replace the spine than it is to install dentures in someone's mouth. The spine protects the nervous system in the body and the nervous system controls every function in the body. For example, the nervous system tells the body to breathe and it tells the heart to beat which are both vital functions to sustain human life. They also tell the muscle fibers when to fire during movement and when to relax when not moving. Spinal Hygiene Exercises are important because they help prevent spinal dysfunction.  When practiced daily these exercises improves posture, repairs and maintains muscular strength, range of motion, and encourages a healthy nervous system. In fact, a study measuring the quality of life (a health-related concept) concludes that spinal hygiene exercises improves the quality of life (Shepard 1).

Spinal hygiene exercises should be done daily as part of a morning and/or evening routine. When practicing spinal hygiene exercises maintain an even breathing pattern, go as far as the body will allow, and notice the body's posture.  Are the shoulders elevated? Is the head in a forward position? Is the pelvis tilted forward? Are the knees extended? Become aware of the body and make necessary adjustments whether you are walking, running, sitting, or standing.

Spinal Hygiene Exercises (TWY)

T- Hold arms out with palms up. Squeeze shoulder blades (contracting rhomboid muscles) for 10 seconds. Relax shoulder blades while arms are still out. Repeat 3 times.20160901_085955

W- hold arms out with palms up. Bend arms at the elbows at 90 degrees. Squeeze shoulder blades (contracting rhomboid muscles) for 10 seconds. Relax shoulder blades while arms are still up. Repeat 3 times.

20160901_090045

Y- Hold arms up in the air with thumbs back, palms facing each other. Squeeze shoulder blades (contracting rhomboid muscles) for 10 seconds. Relax shoulder blades while arms are still up. Repeat 3 times.

20160901_085841

References (Retrieved 8/29/16)

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Sleep It On, Don’t Sleep On It (Best Sleep Positions)

Sleep: The Benefits Sleep can be your muscles greatest training ally. True rest can be the most beneficial thing in a persons training regimen because the body actually builds muscle while you sleep. As the body falls deeper and deeper into sleep, passing from a state of beta rhythm (conscious alert state) through alpha and theta, to delta rhythm (deep sleep/ REM sleep state) the brain signals the paralysis of the skeletal muscles and the pituitary gland secrets the peptide hormone Somatotropin (Also known as growth hormone).

The Hormone Behind the Muscle Building

Somatotropin stimulates muscle growth, cell reproduction and cell regeneration. Essentially, using this hormone, muscles broken down through training are rebuilt and improved. Somatotropin is found in its highest levels in the body during delta rhythm sleep. Therefore an athlete is not optimizing training/recovery without getting optimal sleep.

Lack Of Sleep: The Drawbacks

Sleep or lack there of can also be very detrimental to the body, without the signals from the brain to paralyze the muscles into a complete resting state, the body would continue to break down further due to the muscles reaction to the stimuli of the dreams experienced during sleep. This may occur due to noise pollution in an individual's sleeping environment and or poor sleeping habits, which leads to the question 'which is the best position in which to get a good, restful, muscle repairing nights sleep?'

The answer to that question may not be the most simple. Every sleeping position has its pros and cons.

Positions: Pros and Cons

For instance those who prefer to sleep on their Back benefit from the alignment of the spine and neck while at the same time they are putting pressure on the lordoses of the neck and lower back and the muscles that support them in addition, they are at a higher risk from respiratory restriction or sleep apnea. One solution to this problem is to discontinue the use of a traditional pillow; this forces the head to tilt back allowing the respiratory tract to remain fully open like in the use of CPR.

Areas under pressure and fixes:

Supine-Position

 

Side sleepers can benefit from increased circulation to the heart by sleeping on the left side but at the same time they are putting pressure on the stomach and lung and lateral pressure on the lower back, cervical vertebrae and muscles of the neck, while most likely restricting blood flow to the arm on that side as well. Alternating the side (night to night) that one sleeps on is suggested in order to prevent putting too much strain on the muscles and organs of one side or the other for extended periods of time.

Areas of pressure and fixes:

Pic. ref. 1

 

Stomach sleeping, widely regarded as the worst position to sleep in can be beneficial in digestion (shown in some studies) and decrease the chances of sleep apnea, but the negative affects on the spine and muscles of the back (specifically lower back, this position usually causes the greatest strain in this area) and also the muscles of the neck do to the angle the neck is bent when using a pillow; seem to outweigh any possible benefits from this position.

Areas under pressure and possible fixes:

Pic. ref. 1

 

Block out that white noise, find a comfortable sleeping position that allows you a good night’s sleep, without putting too much strain on those tired muscles and sleep on the gains you’ve been training for.

 

References (retrieved 7/27/16):

  1. http://www.bodybuilding.com/fun/teen-brent3.htmhttps://en.m.wikipedia.org/wiki/Growth_hormone
  2. http://www.hammernutrition.com/knowledge/sleep-builds-strong-muscle-mass.778.html
  3. http://greatist.com/happiness/best-sleep-positions

Picture References (retrieved 7/27/16):

  1. http://activebackcare.com.au/sleeping-positions-to-relieve-back-and-neck-pain

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Neck Pain: Where is Your Head Right Now?

Neck pain is one of the most common complaints we see as massage therapists. And in a world where most people spend the majority of their day on a computer, that’s no surprise. In fact, if you’re reading this blog post, you’re on a computer right now. Time for a pop quiz: Where is your head right now?

Picture 1

Is your head directly over your shoulders? Or is it slightly forward - or even a lot forward? Are you looking straight ahead of you, or is your head tilted down to see the screen?

As a nearsighted person, I have terrible computer posture because I’m always leaning forward to get a closer look at what I’m doing. And as I get tired, my shoulders slump forward and my whole spine rounds forward. When I work at a computer for more than a few hours, my neck turns into one big ache.

But it’s not just our work on computers that can impact our neck. Hobbies and sports can take their toll as well. Cyclists have to have their shoulders down and head up to have proper posture on the road, and this creates chronic compression in the back of the neck. Swimmers are also prone to neck pain, because of the twisting motion required to breathe during the freestyle stroke. Triathlon training is basically a recipe for neck pain - which is why we recommend daily stretching and self care routines for triathletes, office workers, and anyone else who experiences frequent neck pain.

Stretches & Self Care for Neck Pain

These stretches should be done every day for optimal results. As with any home stretching routine, proceed carefully, respect your body’s limits, and stop immediately if you feel a sharp, shooting pain.

  1. Doorway Stretch

This is the stretch I give as “homework” to most of my new clients. It targets the pectoral muscles, which in most of us are too short and too tense. Tight pectorals restrict and shorten the muscles in the front of our neck, and cause pain in the back of the neck and between the shoulder blades.

To perform this stretch, stand in a doorway and anchor your elbows in the door frame on either side of you. Slowly lean forward until you feel a stretch in the front of your chest. Hold for at least 90 seconds.

Picture 2

 

For a more relaxed version of this stretch, try the “Heart Bench” from Martin’s recent blog post, Use it Or Lose it: How Age Affects Flexibility.

  1. Anchored Neck Rolls

This exercise can also be done in a doorway, or it can be done sitting in a chair. For this exercise, shrug your shoulders back and down your back, and then hold onto the seat of the chair or the edges of the doorway in order to help your shoulders stay in place. Then, gently begin to roll your head counterclockwise on your neck. Let it drop forward, then to the right, then slightly back, and to the left, and forward again. Take deep breaths and pay attention to any areas of tightness. When you find a stretch that feels good, stay there for 30 seconds to 2 minutes. You can even use the opposite hand to gently assist in the stretch.

Picture 3

 

  1. Tennis Ball Massage

Tennis balls make wonderful self-massage tools. You can lie on the floor and place tennis balls right where the skull rests on the neck, moving your head back and forth to feel the massage. Tennis balls also feel great at the junction of the shoulder and neck, and right between the shoulder blades. You could even lie face down and place the tennis ball just inside your armpit for a nice pec massage.

Picture 4

 

Other Tips

Hot and cold compresses can feel wonderful on a sore neck. Try putting a towel in the freezer, or investing in a Magic Bag, Bed Buddy, or other similar hot/cold wrap.

Over-the-counter pain medications such as Advil, Tylenol, or aspirin can be helpful, but taking too many of them can have a variety of adverse health effects. If you find yourself needing to take pain medication regularly, talk to your doctor. And always let your massage therapist know if you’ve taken pain medication before you come in for your massage.

 

References (retrieved 6/27/16):

  1. http://www.spine-health.com/conditions/neck-pain/neck-stretches
  2. http://pbmassagetherapy.com/desk-workers-part-2-postural-exercises/
  3. http://www.cyclingweekly.co.uk/videos/fitness/neck-pain-after-cycling-try-these-exercises
  4. https://learntomove.org/2015/02/03/pec-stretches/
  5. http://www.drhakes.com/patient-education/patient-exercises-6/cervical-spine-(neck)-exercises-40/
  6. https://www.buzzfeed.com/annaborges/everything-hurts-and-im-dying?utm_term=.udZ5e9EP7K#.av3vyExYeQ

Picture References (retrieved 6/27/16):

  1. https://en.wikipedia.org/wiki/Posture_(psychology)
  2. https://learntomove.org/2015/02/03/pec-stretches/
  3. http://www.drhakes.com/patient-education/patient-exercises-6/cervical-spine-(neck)-exercises-40/
  4. https://pixabay.com/en/photos/net/

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Shin Splints Or Medial Tibial Stress Syndrome

IMG_2102Shin splints are a common sports injury, especially amongst beginner runners or those starting a new high impact activity. Maybe you’ve had them at some point: it is a pain in the lower leg, along the inner part of the tibia.In spite of the fact that they are so common, there isn’t a clear histological description of shin splints. However, in most cases, conservative treatment seems to be effective, and there are known preventive measures that work.

Definition

When the term was originally coined, shin splints referred to any pain in the lower leg. Now, there are multiple diagnosis for shin pain and the term shin splints is generally reserved for Medial Tibial Stress Syndrome (MTSS).

MTSS creates pain in the inner part of the shin, along the Tibial bone. It is usually spread over at least 5 cm (2 in) and there may or may not be swelling involved. There is no consensus on the physiopathology of shin splints, some saying that it is caused by micro-tears in the soft tissue attaching to the Tibia (Tibialis Posterior muscle, Soleus, or Interosseus Sheath), others say it's periostitis (inflammation of the connective tissue that surrounds the bone), while others believe it is the bone itself that is overloaded, resorbing itself faster than it forms.

Risk factors

11214228_10153474186589916_6973547518441075677_n

Shin splints are a sports injury linked to overuse.

Extrinsic risk factors include:

  • Repetitive high impact sports (running, gymnastics, basketball, …)
  • Over-training
  • Sudden increase in intensity or distance
  • Less running experience
  • poor or hard running surfaces
  • improper footwear

Intrinsic risk factors include:

  • Over-pronation of the foot (flat feet)
  • Women are at higher risk
  • Past shin splints
  • Being overweight or having weak calves may be contributing factors

Treatment

  • Rest for several weeks from the activity that causes pain. Gradually return to that activity after being completely pain-free.
  • Pain relievers or anti-inflammatory medication may be advised by your doctor.
  • Compression such as compression socks or calf sleeves help relieve symptoms.
  • Icing the area participates in decreasing inflammation and provides pain relief. Ice 20min several times a day.

Note: some compression sleeves have pockets for ice so that compression and icing can be combined in one step [11]. 

  • Massage: a massage therapist will loosen the lower leg muscles and eliminate knots to decrease the load on the tibia. Work will be focused on the calf and the Tibialis Posterior. The session will include deep tissue massage, cross fiber friction and stretching to those muscles. Care will be taken to avoid the bone itself, so as not to aggravate it or the insertion points of soft tissue. At the end of a massage session, your therapist will recommend self-care exercises that may include:
    • Self massaging the calves with a foam roller (see photo A, below)
    • Self massaging the Tibialis Posterior with your thumb (see photo B, below)
    • Gastrocnemius (superior and more superficial part of the calf) stretching (see photo C, below)
    • Soleus (deeper part of the calf) and Tibialis Posterior stretching (see photo D, below)

(A) Place your calf on the foam roller, with the other leg on top. Lift your hips and roll your calf up and down the foam roller, as well as side to side.

IMG_2113

 

 

 

 

 

 

 

(B) Use your thumbs to massage the soft tissue by the tibia. Apply circular motions for 2-3 minutes with medium pressure.

 

 

 

 

 

 

 

(C) Place the front part of your foot on the edge of a stair and let the heel fall, stretching the calf. Your knee is straight.

IMG_2116

 

 

 

 

 

 

 

(D) Place the front part of your foot on the edge of a stair and let the heel fall, stretching the calf. Your knee is bent.

IMG_2118

Prevention

  • Changing shoes: while advocates of barefoot running claim it is helpful for shin splints, there is no evidence to support this. On the contrary, using arch supports or changing to shock-absorbing insoles seems to be a more effective way to prevent shin splints. [4]
  • Gradual increase in work-load: make sure to follow a training program adapted to your level and to increase intensity gradually. If you miss several weeks of training, don't "jump" to where you should be or do a lot to make up for the missed weeks, but rather build progressively from where you are.
  • Cross training: a balanced fitness regimen consists of 3 components: cardio, strength and stretching:
    • Cardio: consider switching one or more of your high impact workouts for another cardio workout that is less stressful on your Tibia. For instance, a runner may consider switching one of his/her runs for cycling or swimming.
    • Strength: strengthening your leg muscles with exercises such as squats and lunges will help provide support to your lower leg structures. One-legged exercises or exercises on an uneven ground (such as on a Bosu ball) will target more specifically the lower leg stabilizers. A physical therapist might also prescribe targeted Tibialis Anterior (see photos E and F, below) (this muscle is at the front of the lower leg – strengthening it will counter-balance tight calves) or calf strengthening exercises (strong calves protect the Tibial bone).
    • Stretching the lower leg muscles will decrease their tightness and the appearance of knots: stretch your calves and Tibialis Posterior, actively before an activity, passively after.
  • Massage therapy: regular massage sessions can help keep muscles loose as a preventive measure.

(E) (F) Place your back against a wall, your feet away from the wall. Lift your toes so as to contract the Tibialis Anterior, then place on the floor. Repeat 10 times and do 3 sets.

 

 

 

 

 

For runners, I recommend heading to Philadelphia Runner [12] to purchase appropriate footwear. All the staff are experienced runners who will be able to assess your gait and provide adequate shoes. They also created Team Philly [13] (for which Phila Massages is a partner) that offers training programs, weekly group runs, running questions support, access to a Physical Therapist, ...

Other shin pains

Some practitioners may consider only MTSS to be shin splints, others may use the term for other conditions, some of which are described below, while others still may use the terms "true"/"false" or “anterior”/”posterior” shin splints depending on the shin pain - there currently is no medical consensus on the term “shin splints”.

Chronic compartment syndrome

This condition is rare: pain is usually located in the front part of the shin. It is caused by bleeding or inflammation of the lower leg muscles. These muscles are encased in a tough fascia and if that fascia is too tight, these changes increase the pressure in that area, causing pain. Pain decreases when stopping exercise, numbness can occur. Treatment is similar to that of MTSS except the target muscles/areas will differ.

Note: acute compartment syndrome is very rare and is caused by dangerous pressure elevation in the lower leg. In this case, the pain is acute, increases, and doesn’t go away after rest: it is a medical emergency.

Tendonitis

Tendonitis is an inflammation of a tendon: Tibialis Posterior, Tibialis Anterior or Peroneus can be culprits. Treatment is similar to that of MTSS except the target muscles/areas will differ.

Stress fractures

A differential diagnosis for shin splints may be a stress fracture, which is a small crack in the Tibia. Pain is not spread, can be pinpointed to a specific area, and doesn't improve after treatment recommended for the above conditions. It is diagnosed by an MRI (though doctors might choose not to do this expensive imaging and diagnose only by a clinical evaluation) and generally requires a boot for 6-8 weeks.

Because there is no consensus on the definition and etiologic factors contributing to shin splints, treatment can be challenging, stressing the importance of prevention. If you think you have shin splints, and as with any other sports injuries, make sure to see your doctor first. Then, if it's appropriate, the Phila Massages team will be able to help you with your recovery or for prevention.

 

References (retrieved 5/20/16):

  1. http://link.springer.com/article/10.2165/00007256-200939070-00002
  2. http://www.legalpointer.net/healthtopics.php?&A=&I=&article=445941
  3. http://www.podiatryinstitute.com/pdfs/Update_2015/2015_21.pdf
  4. http://orthoinfo.aaos.org/topic.cfm?topic=A00407
  5. http://orthoinfo.aaos.org/topic.cfm?topic=A00204
  6. http://publications.amsus.org/doi/abs/10.7205/MILMED.171.1.40
  7. http://youtu.be/WIQsLfFQSQ0
  8. http://www.sportsinjuryclinic.net/sport-injuries/ankle-achilles-shin-pain/shin-splints/shin-splints-stretching-exercises
  9. http://www.drpribut.com/sports/spshin.html
  10. https://runnersconnect.net/running-injury-prevention/the-ultimate-guide-to-shin-splints-for-runners/
  11. An example of Compression and icing gear (I found this while doing a search on Amazon – I have not personally tried it and am inserting the link to illustrate the type of product mentioned): 110 Percent Play Harder Double Life Shin/Calf Compression Sleeves + ICE for Shins and Calves, Black, Size 1, X-Small https://www.amazon.com/dp/B004M63Y7Y/ref=cm_sw_r_cp_api_QYhpxbEY5Z55B
  12. Philadelphia Runner: http://philadelphiarunner.com/
  13. Team Philly: http://www.meetup.com/TeamPhilly/

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Use It Or Lose It: How Age Affects Flexibility

We all remember that test in gym class, the famous V-sit and Reach. The one that had us sit upright as we effortlessly bent forward at the waist reaching out beyond the tips of our toes to the floor beneath us. Fast forward a few decades later, and how many of us would now consider ourselves lucky to settle for half of that? Maybe it’s the shins, or maybe just grasping hold of the knees is taking it to your edge. What changes do our bodies go through over time that makes our flexibility weaker and weaker as we age, and how do we prevent this? Components of flexibility

The musculoskeletal system is arguably the most complex system in the body, composing of the bones, muscles, cartilage, tendons, ligaments, joints and other connective tissue that provides support, stability, and protection to the organs. Many different actions need to happen in order to activate a simple muscle contraction. Muscles are able to contract, lengthen and stretch because of their unique physiology, a property called elasticity. As the human body ages, or if we do not utilize its need for movement,  it loses this natural ability to stretch and restore itself, slowly limiting range of motion and eventually leading to chronic tightness.

Variable factors such as muscle loss, lifestyle habits and the breakdown of cartilage between the joints also play an important role in flexibility and general mobility. Joints are the meeting point of two bones. Instead of each bone coming in direct contact with one another, a padding of cartilage and synovial fluid comes between the two ends. Over time, the fluids and cartilage begin to decrease and wear away. This explains why it becomes more difficult to become limber as we age. In addition, minerals may build up around the joints, a process called calcification, and could also contribute to stiffness. However, by keeping a persistent stretching regimen and performing light muscle bearing exercises, one could combat the effects of aging on the muscular system.

Stretch and Restore

Unlike dynamic stretching which is favored more as an active warm-up to a particular physical activity, static stretching involves stretching while the body is at rest and passively holding the stretch anywhere from a few seconds to few minutes. More and more yoga schools are now adapting this “yin” style into their offered courses. The benefit of holding a stretch for longer periods allows you to tap into the deeper layers of connective tissue, stimulating a healthy stretch into the tendons and ligaments and not just the muscle belly as with a quickly administered dynamic stretch. On a cellular level, you increase the production of hyaluronic acid (HA) which has the same lubricating effect for your joints as motor oil has for your car. While both forms of stretching may slightly differ in approach, both remain to be a vital component for maintaining flexibility and healthy range of motion. Below are some examples of yin stretches. Keep in mind this is a more passive stretch, meaning you want come into the stretch at your comfortable max, or about 70%. You should be able to stay in each pose without fidgeting for 3-5 minutes. Props such as yoga blocks and bolsters are encouraged to enable you to fully surrender into each stretch.  Also keep in mind that there are plenty of other ways to stay active and one should experiment with different types of exercise.

Over time, the changes to our musculoskeletal system result more from disuse and our inclination to become more sedentary than from aging alone. Which is why if don’t use it, we lose it!

Pose: Pigeon (aka Sleeping Swan)

Areas of focus: outer hips/glutes

Variation: Bolster or block underneath hip

Picture1 Picture2 Picture3 Picture4

Pose: Wide-Legged Child’s Pose

Areas of focus: Inner groin/mid back

Variation: Thread arm through with upper body twist. Area of focus: Upper mid-back/shoulder blades

Picture7 Picture6

Pose: Dragonfly

Areas of focus: Posterior legs

Variation: Sitting on bolster to elevate hips and/or bolsters underneath both knees. Block to rest your head

Picture8 Picture9

Pose: Saddle

Areas of focus: Anterior legs

Variation: Pillow behind the knees

Picture10 Picture11 Picture12

Pose: Heart Bench

Areas of Focus: Upper chest

Setup: One block between shoulder blades, one at the base of skull

Picture14 Picture13

Sources (retrieved 5/4/2016):

This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.